The American surgeon
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The American surgeon · Apr 2000
Randomized Controlled Trial Comparative Study Clinical TrialFurther evaluation of colostomy in penetrating colon injury.
Our objective was to compare, in a randomized prospective format, complication rates associated with primary repair versus fecal diversion in penetrating colon injury. During a 72-month period, 181 patients with penetrating colon injuries were entered in a randomized prospective study at an urban Level I trauma center. After intraoperative identification of colon injuries, patients were randomized to a primary repair or a diversion group. ⋯ There were 18 (21%) septic related complications in the diversion group and 16 (18%) in the primary repair group (P > .05). With respect to risk factors, complication rates were not higher in one study group versus the other. We conclude that, in the civilian population, all penetrating colon injuries should be managed with primary repair.
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The American surgeon · Apr 2000
Opioid and benzodiazepine withdrawal syndrome in adult burn patients.
The prolonged use of continuous intravenous sedation [benzodiazepines (BZDs)] and pain medication [opioids (OPs)] is now common in intensive care units. Few studies have evaluated the characteristics that may lead to an acute withdrawal syndrome when these long-term medications are withdrawn. Those studies that have made recommendations for weaning rates to prevent withdrawal have given these recommendations with minimal data to support their recommendations. ⋯ There was a significant relationship between the rate of BZD/OP weaning in the terminal drug withdrawal phase and the percentage of days that patients experienced withdrawal symptoms (P < 0.005). Those patients who underwent a prolonged terminal weaning from these medications experienced fewer symptoms. The optimal rate of weaning that would allow decreased ventilator and intensive care unit length of stay without development of acute withdrawal symptoms is yet to be determined.
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The American surgeon · Apr 2000
Clearing the cervical spine in victims of blunt assault to the head and neck: what is necessary?
A number of guidelines have been proposed to aid in determining the need for radiologic evaluation of the cervical spine (c-spine) in victims of blunt trauma. Mechanism of injury has not been shown to be an independent predictor of injury or the lack thereof. The current study was undertaken to determine the incidence of clinically relevant c-spine injuries in patients who sustained a blunt assault to the head and neck. ⋯ The possibility of ligamentous injury was investigated by MRI or flexion/extension radiographs in 26 patients. No clinically significant c-spine injuries were identified. Although many victims of a blunt assault to the head and neck region may have a decreased LOC or neck pain, the likelihood of a ligamentous injury is so low that plain-film X-ray evaluation of the c-spine is all that is necessary to rule out injury in this patient population.
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The American surgeon · Apr 2000
Nonoperative management of blunt liver trauma: the value of follow-up abdominal computed tomography scans.
Our hypothesis was that follow-up abdominal CT scans are not routinely necessary in patients with blunt liver injury treated nonoperatively. We conducted an 8-year retrospective review of hospital chart and outpatient clinic records. We reviewed all admission and follow-up CT scans. ⋯ Additional late follow-up CT scans were obtained in 13 patients; no clinically useful information was evident on any of these examinations. We conclude that follow-up abdominal CT scans are not routinely necessary in patients with liver injuries treated nonoperatively. Selective criteria based on the severity of liver injury, presence of associated intra-abdominal pathology, and clinical parameters should dictate the need for follow-up imaging studies.
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A porcine model of hemorrhagic shock was used to study the effect of hypothermia on hemodynamic, metabolic, and coagulation parameters. The model was designed to simulate the events of severe blunt injury with hemorrhage occurring initially, to a systolic blood pressure of 30 mm Hg, followed by simultaneous hemorrhage and crystalloid volume replacement, followed by cessation of hemorrhage and blood replacement. Half of the animals were rendered hypothermic by external application of ice, and half remained normothermic. ⋯ We conclude that when shock and hypothermia occur together, their deleterious effect on hemodynamic and coagulation parameters are additive. The effects of hypothermia persist despite the arrest of hemorrhage and volume replacement. Thus, it is necessary to aggressively address both shock and hypothermia when they occur simultaneously.